RUTHFULLY YOURS

Hillary Clinton’s health has become a campaign issue, not due to conspiracy theorists but based on troubling videos of her bizarre facial tics, difficulty ascending a set of stairs, lengthy coughing fits, and her collapse after the 9/11 anniversary commemoration in Manhattan. More recently, there is video showing Mrs. Clinton’s eyes not tracking together, crossing and misaligning.

As the focus of the campaign turns to Russian hacking, rigged elections, and sketchy polls, Mrs. Clinton’s health has moved off center stage. Yet it still a legitimate concern. Although she has not stumbled or had a public coughing fit, her nontracking eye movements continue to be apparent. Not to big media, which are far more interested in the latest Trump accuser, a porn star who just happens to be opening an online sex store. Yet her crossed eyes resurfaced most recently at a Cleveland campaign appearance a few days ago. The only thing missing is her campaign blaming the Russians.

What do these abnormal eye movements suggest about her neurologic health? In 2012 Mrs. Clinton fell, suffering a concussion and a brain hemorrhage requiring treatment with Coumadin, a potent blood thinning medication. More than simply a bump on her head, but instead “a terrible concussion that required six months of very serious work to get over” according to her husband Bill Clinton.

More specifically, she suffered a cerebral venous thrombosis, a large blood clot in her transverse venous sinus. These sinuses collect blood draining from the brain and can be injured via trauma or a variety of medical conditions which increase blood clotting tendencies.

As an aside, blood clots are not just a recent problem for Mrs. Clinton. She suffered a blood clot in 1998 when she was first lady, and only in her mid-50s. Typically blood clots at this age signify an underlying clotting disorder, likely a genetic defect in the clotting cascade. This might explain her subsequent problems a decade later. Her blood clot when she was first lady was only recently revealed, consistent with Mrs. Clinton’s penchant for secrecy and lack of transparency.

Late complications of cerebral venous thrombosis include speech impairment, difficulty with body movement, seizures, and altered vision, including double vision. Watching the many videos of Mrs. Clinton suggest that she has suffered all these complications.

The most recent videos show her eyes not tracking together, crossing as she gazes from one side to the other. Eye movement is controlled by six muscles attached to each eye, allowing eyes to move up, down, diagonally, and rotationally. These muscles are in turn controlled by a combination of three cranial nerves originating in brain stem, an area between the brain and spinal cord, then travelling upward to the eyes.

Mrs. Clinton’s original trauma and blood clot likely damaged at least one of her cranial nerves. During Congressional testimony over Benghazi, she was wearing eyeglasses with Fresnel prisms, used to correct double vision due to eye misalignment. But that was four years ago. Why are her eye movements still misaligned?

Synkinesis is a condition where nerves rewire incorrectly after trauma. This may cause one eye to look left or not move at all when the brain tells it to move right. Smiling or chewing may cause the eyes to move, which would explain Mrs. Clinton’s abnormal eye movements while giving a recent speech.

Funny eye movements alone are no big deal. Many people have a crossed eye, called strabismus, due to a childhood lazy eye, previous eye injury or surgery, or a small stroke of one of the cranial nerves. But in Mrs. Clinton’s case, there are other worrying signs, including possible seizure activity, her recent collapse, coughing fits, all on top of her history of head trauma, blood clot, and ongoing anticoagulation therapy.

Physicians are much like detectives. Sherlock Holmes is a fictional detective, created by Arthur Conan Doyle, a physician himself who briefly studied ophthalmology. Physicians observe, ask questions, gather information, and make deductions. I am writing, not as Mrs. Clinton’s physician, but as an ophthalmologist and political observer. Clearly she has health issues, and to most reasonable observers, her signs and symptoms suggest significant neurologic disease. What her condition is specifically is the subject of speculation. More blood clots, Parkinson’s disease, malignancy, who knows?

This is not the 68-year-old pensioner living down the block but a potential commander in chief. John McCain’s health was the subject of much media analysis and consternation in 2008. Was he too old? Could his cancer return? Interestingly, eight years later he is alive and well, seeking yet another term in the U.S. Senate.

Hillary Clinton’s health and fitness for the presidency deserves similar scrutiny. If she has a neurologic condition, will it affect her thinking and judgement? Will she be coherent and clear headed when her famous 3 A.M. phone call comes in? If she is not, who will be making critical decisions? Bill Clinton? Huma Abedin? John Podesta? Cheryl Mills? Sid Blumenthal?

The only question is whether the media will treat Mrs. Clinton’s medical status with the same degree of urgency as they treat every one of Donald Trump’s utterances or accusers?

Brian C Joondeph, MD, MPS, a Denver based physician and writer. Follow him on Facebook and Twitter.